Implantable Cardiac Device Using Endocardiac Acceleration for Pacing Optimization
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Solution Overview
Problem
Current CRT devices for cardiac resynchronization therapy lack efficient methods for long-term monitoring of patient response and optimization of pacing configurations, relying on expensive ultrasound-based evaluations and requiring frequent clinical interventions.
Innovation Solution
An active implantable medical device that collects endocardiac acceleration data to evaluate patient clinical status by testing various pacing configurations and deriving parameters from endocardiac acceleration peaks, allowing for remote monitoring and optimization of pacing settings.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Measurement precision
If ultrasound-based evaluation techniques are used to evaluate patient response to CRT therapy, then measurement precision is improved, but device complexity and cost increase, and ease of operation deteriorates
Solution Approach 1:
The patent replaces the mechanical/external ultrasound-based evaluation system with an integrated electrical sensing system within the implantable device. The device uses sensing electrodes to detect endocardiac electrograms and processes these signals internally to evaluate ventricular contraction synchronization, eliminating the need for external ultrasound equipment and complex clinical procedures.
Solution Approach 2:
The implantable device performs self-evaluation of its own therapeutic effectiveness by continuously monitoring endocardiac electrograms and automatically analyzing ventricular contraction synchronization. The device compares sensed signals from different ventricular sites to determine whether the pacing configuration is achieving proper resynchronization, without requiring external medical equipment or expert intervention.
2Measurement precision
If frequent clinical interventions are performed to monitor patient response, then measurement precision is improved, but loss of time and productivity deteriorate
Solution Approach 1:
The device enables continuous monitoring of ventricular contraction synchronization by continuously sensing endocardiac electrograms and automatically analyzing the timing relationships between ventricular depolarizations. This continuous evaluation replaces intermittent clinical visits with ongoing automated assessment, providing persistent monitoring without requiring repeated hospital appointments.
Solution Approach 2:
The device implements a feedback mechanism where sensed endocardiac electrograms are continuously analyzed to evaluate ventricular resynchronization effectiveness, and this information can trigger alerts or notifications to clinicians when optimization is needed. The system provides automated feedback on therapeutic effectiveness, reducing the need for frequent manual clinical assessments.
3Adaptability or versatility
If multiple pacing configurations are tested to optimize therapy, then adaptability is improved, but device complexity and measurement precision requirements increase
Solution Approach 1:
The device incorporates dynamic switching capabilities that allow it to test and transition between multiple pacing configurations (such as different ventricular pacing sites and atrioventricular delays) based on real-time analysis of endocardiac electrograms. The system can dynamically adjust pacing parameters to optimize ventricular resynchronization effectiveness for each patient's specific cardiac anatomy and physiology.
Solution Approach 2:
The device performs preliminary testing of different pacing configurations during implantation and follow-up by systematically evaluating various ventricular pacing sites and timing intervals using endocardiac electrogram analysis. This preliminary assessment identifies the optimal pacing configuration before committing to long-term therapy, ensuring proper resynchronization is achieved.
Applied Scientific Principles
This section explains which scientific principles are used to turn an abstract innovation direction into a practical engineering solution.
Function Achieved in This Case
Enables continuous, cost-effective evaluation of patient response to cardiac resynchronization therapy, reducing the need for frequent clinical interventions and improving long-term monitoring of ventricular function, thereby predicting potential heart failure episodes.
Implementation Method 1
an accelerometer directly in contact with the cardiac muscle (generally, but not exclusively, at the right ventricle apex, sometimes in the right atrium) very precisely reflects, in real time, the converging phenomenon of the mechanical functioning of the heart
Data Source
AI summary
A medical device for characterizing the cardiac status of a patient equipped with a bi-ventricular pacing active implant device. The implant collects an endocardiac acceleration signal and searches for an optimal pacing configuration. This latter tests a plurality of different pacing configurations and delivers for each tested configuration parameters derived from the endocardiac acceleration peak (PEA). The device derives a patient clinical status from those parameters, the indication being representative of the patient's response to the cardiac resynchronization therapy. Those parameters include: the possibility to automatically get or not a valid optimal AV Delay among all the biventricular pacing configurations; a factor indicating the character sigmoid of the PEA/AVD characteristic; the average value of the PEA for the various configurations; and the PEA signal/noise ratio. The active implantable medical device includes control software and processes for executing the characterizing functionality described.